摘要
目的探讨血管内超声(IVUS)技术在非血栓性髂静脉受压综合征(NIVCS)诊断和治疗中的价值。方法回顾性分析2011年1月至2017年1月收治的4 823例下肢静脉曲张患者临床资料。其中行下肢静脉造影患者共324例,CT和临床症状高度怀疑NIVCS且造影无法明确腔内治疗手术指征时进一步作IVUS检查,造影或IVUS检测结果明确髂静脉狭窄>50%时行球囊扩张和支架植入术。结果本组确诊NIVCS患者165例,其中单纯静脉造影确诊81例(49.1%),进一步由IVUS确诊84例(50.9%)。造影、IVUS显示平均狭窄率分别为(33±18)%、(78±16)%(狭窄病变直径与IVUS导管直径相等时狭窄率为100%)(P<0.01)。以IVUS为标准,默认IVUS检测狭窄率>50%为阳性,则髂静脉造影灵敏度为49%。本组患者保守治疗34例,植入支架131例(左侧病变102例,右侧病变21例,双侧病变8例)。随访6~36个月,平均27.4个月,术后12个月支架一期通畅率100%。结论 NIVCS诊断和治疗中采用IVUS检查能更为准确地评估狭窄率、检测管径、评估支架植入后情况,在部分髂静脉造影无法明确狭窄率及腔内介入手术指征情况下,可为治疗决策提供有力支持。
Objective To discuss the clinical value of intravascular ultrasound（IVUS） in the diagnosis and treatment of non-thrombotic iliac vein compression syndrome（NIVCS）. Methods The clinical data of4823 patients with varicose vein of lower limb, who were admitted to authors＇ hospital during the period from January 2011 to January 2017, were retrospectively analyzed. Among them, 324 patients underwent venography of lower extremity. For patients, whose CT findings and clinical symptoms strongly suggested the diagnosis of NIVCS and whose angiography could not provide definite indication of endovascular surgery,further IVUS examination was carried out. Balloon dilatation and stent implantation were performed if angiography or IVUS confirmed that the stenosis of iliac vein was 50%. Results The diagnosis of NIVCS was confirmed in 165 patients, among them the diagnosis was proved by venography alone in 84 patients（50.9%）. The mean stenosis rates detected by angiography and IVUS were（33 ±18）% and（78 ±16）%respectively（the stenosis rate was 100% when the diameter of stenosis was equal to IVUS catheter diameter）（P〈0.01）. Taking IVUS measurement as the standard, the sensitivity of iliac venography for NIVCS was 49%if the stenosis rate 50% measured on IVUS was identified as a positive index. In this series, conservative therapy was employed in 34 patients, implantation of stent was adopted in 131 patients, including left side lesions（n=102）, right side lesions（n=21） and bilateral lesions（n=8）. The patients were followed up for 6-36 months, with a mean of 27.4 months. Twelve months after the treatment, the primary patency rate of stent was 100%. Conclusion In the diagnosis and treatment of NIVCS, IVUS can more accurately assess the stenosis rate, measure the venous diameter, and evaluate the status of implanted stent. Under the circumstances when iliac venography can＇t determine the accurate stenosis ratio and can＇t demonstrate definite indication of endovascular interventional therapy, IVUS can provide strong support for the making of therapeutic decision.
作者
王翔
周斌
陈国君
洪毅
葛进
李钦传
WANG Xiang;ZHOU Bin;CHEN Guojun;HONG Yi;GE Jin;LI Qinchuan(Department of Vascular Surgery,Shanghai East Hospital,Tonal University,Shanghai 200120,China)
出处
《介入放射学杂志》
CSCD
北大核心
2018年第9期822-826,共5页
Journal of Interventional Radiology
基金
上海市浦东新区卫生计生委科研项目(PW2017B-7)
